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Comprehensive Geriatric Assessment in Primary Care

Lynn Lansbury is NIHR CLAHRC Principal Investigator in Academic Geriatric Medicine at the University of Southampton. Here she talks about CGA in Primary Care, which she shares on Twitter @CGA_GP

Adam Gordon's blog introduced a timely study. With an ageing population it is important that we develop services that are fit for the changing demographic. There is convincing evidence that Comprehensive Geriatric Assessment (CGA) has a place in best practice for the care of older people. The evidence base is particularly strong in acute settings and studies have also been carried out in people’s homes. The Proactive Healthcare for Older People in Care Home (PEACH) study explores CGA in care homes Thus there is interest in identifying the place of CGA in other settings. Our new study, Comprehensive Geriatric Assessment in Primary Care (CGA-GP): The Fit for Later Life Project funded by NIHR CLAHRC Wessex, investigates the GP surgery as a setting.

The rationale for delivering CGA in the GP surgery is that this provides a half-way house between secondary care clinics and home-based CGA. This meets the needs of many patients and maximises primary-secondary care liaison whilst being less resource intensive than home-based visits. Intuitively this seems persuasive but there is little evidence about the implementation of such an approach. Therefore CGA-GP was designed to assess the feasibility, acceptability and cost of providing a patient-centred service, closer to home and in a familiar setting. The project considers the perspectives of all stakeholders.

CGA-GP was launched in January 2016. The project consists of the following:

Qualitative interviews and focus groups with staff, patients and carers on the usual care of older patients in primary care.

A clinical audit of patient records to anonymously characterise the practice's patients aged 75 years and older, particularly in relation to frailty.

A Normalisation Process Theory focus group with staff to identify strengths and overcome barriers prior to the launch of the CGA clinic in primary care.

Qualitative interviews and focus groups with staff, patients and carers on their experience of the new CGA clinic in primary care.

Quantitative analysis of the medical records of patients who receive a CGA in primary care for comparison with the characteristics of the practice's patients aged 75 years and older.